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Electronic control in acquired spasticity
78
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
The clinical features did not appear for at least 48 hours in this small series and were at first ascribed to the effects of the head injury. Characteristically there was paralysis up to severe hemiplegia, with more or less dysphasia when the left artery was affected. Diagnosis was made by carotid angiography, which showed the appearance of rolled-up intima in 1 case. Clot was removed with success in 2 cases; not all was removed in a third and no operation was performed on the fourth. These last 2 patients showed no improvement. Intimal tears should be repaired and stripped-up intima should be removed. LITTLE, J. M., MAY, I., VANDERFIELD, G. K., and LAMOND, S. (1969), ' Traumatic Thrombosis of the Internal Carotid Artery ', Lancet, 2, 926.
Temporal Artery Aneurysm These Toronto surgeons report 2 examples of traumatic aneurysm of the temporal artery, making a total of 116 in the English literature. Since this aneurysm is superficial, the diagnosis and surgical removal is simple. LAU, C., and KNUTSON, G. H. (1969). ' Traumatic Aneurysm of the Temporal Artery: A Report of Two Cases ', Can. J. Surg., 12, 453.
Injury July 1970
radiologically and sometimes a clear diagnosis cannot be made from anteroposterior, lateral, and oblique views. It may be necessary to take further radiographs with traction and in flexion. Sometimes tomograms are indicated. Widening of the space between spinous processes indicates disruption of the interspinous ligament, which with unilateral locking of the facets point to an unstable cervical segment. In such unstable cervical spines fixed traction is an urgent necessity because 1 in 10 patients with neck injury had a worsening of neurological damage during emergency care before skull traction had been applied. Treatment may be by continuous traction after reduction followed by support, or operative stabilization. If locking of the articular facets cannot be reduced by traction alone, open reduction and stabilization is required. Flexion injuries with subluxation are notorious for the rate of recurrence of deformity, and stabilization by wiring and grafting is required. It is important that the anaesthetist does not use a laryngoscope. Details of time required for traction and fixation as well as prognosis are clearly stated. AUFRANC, O. E., JONES, W. N., and BIERBAUM, B. E. (1969), ' R o t a r y Fracture-dislocation of the Cervical Spine ', J. Am. reed. Ass., 208, 1384.
Spinal Cord and Cauda Equina Bullet Injuries Tractor Driver's Spine In this paper the author claimed that the incidence of spinal degeneration is relatively high in rural populations and this is attributed to the repeated vibrational or rotational trauma to which the tractor driver's spine is exposed. It is suggested that one of the factors involved is a bad design of tractor seats as the more modern tractors do not have the original long steel spring which carried the seat on early models. An appeal is made for the better design of tractor seats and this is clearly directed to the manufacturers themselves. TROUP, J. D. (3. (1969), ' The Spine of the Tractor Driver ', Rural Med., 1, 9.
Great Toe Extensor Reflexes The tendon reflexes of the great toe are weakened by lesions of the fifth lumbar nerve-root. These reflexes require both care and practice if they are to be elicited reliably: the correct method is described in detail. TAYLOR, T. K. F., and WIENER, M. (1969), ' Great Toe Extensor Reflexes in the Diagnosis of Lumbar Disc Disorder ', Br. reed. J., 2, 487.
Snowmobile Injuries The commonest injury from riding Snowmobiles was compression fracture of one or more vertebral bodies due to a bumpy ride in a machine without shockabsorbing equipment. CHISM, S. E., and SOULE, A. B. (1969), ' S n o w mobile Injuries ", J. Am. med. Ass., 209, 1672.
Fracture-dislocation of Cervical Spine The fracture of the month (No. 95) presented by Dr. Boland from the Fracture Clinic of the Massachusetts General Hospital was a fracture-dislocation of the cervical spine. The important features of this injury are clearly outlined. It is frequently missed
The authors describe 65 civilians who had spinal cord or cauda equina bullet injuries. Forty-five had laminectomy and exploration and 20 did not. In all patients, no matter what category, recovery of neurological function was scant or absent. The follow-up showed that the patients with the cauda equina injuries fared better than those with spinal cord injuries. Predictions of the outcome on the basis of cerebrospinal fluid dynamics were not possible. The final state in these patients is closely correlated with the initial neurological situation rather than with surgery. It is suggested that laminectomy should be reserved for contaminated wounds and for cases where there is a progressively increasing neurological deficit. YASHON, D., JANE, J. A., and WHXTE, R. J. (1970), 'Prognosis and Management of Spinal Cord and Cauda Equina Bullet Injuries in Sixty-five Civilians ', J. Neurosurg., 32, 163.
Electronic Control in Acquired Spasticity For those concerned with the increasing problem of spasticity following severe head injuries there is some hope of improving the equinus position if a device described comes into general use. The article describes the effects of automatic electrical stimulation of nerves, especially the peroneal nerve. Useful results were obtained in the parallel problem following strokes. DIMITRIJEVIC, M. R., GRACONIN, F., PREVECT, T., and TRONTEU, J. (1968), 'Electronic Control of Paralysed Extremities ', Biomed. Engng, 3, 8.
Racecourse Medical Officer Years of experience have been distilled into ten minute's delightful reading. Any doctor who has undertaken similar duties will appreciate the excellent presentation of medical care at Cheltenham racecourse. The organization of medical cover, the types of injury to jockeys and spectators, and aspects of
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
The clinical features did not appear for at least 48 hours in this small series and were at first ascribed to the effects of the head injury. Characteristically there was paralysis up to severe hemiplegia, with more or less dysphasia when the left artery was affected. Diagnosis was made by carotid angiography, which showed the appearance of rolled-up intima in 1 case. Clot was removed with success in 2 cases; not all was removed in a third and no operation was performed on the fourth. These last 2 patients showed no improvement. Intimal tears should be repaired and stripped-up intima should be removed. LITTLE, J. M., MAY, I., VANDERFIELD, G. K., and LAMOND, S. (1969), ' Traumatic Thrombosis of the Internal Carotid Artery ', Lancet, 2, 926.
Temporal Artery Aneurysm These Toronto surgeons report 2 examples of traumatic aneurysm of the temporal artery, making a total of 116 in the English literature. Since this aneurysm is superficial, the diagnosis and surgical removal is simple. LAU, C., and KNUTSON, G. H. (1969). ' Traumatic Aneurysm of the Temporal Artery: A Report of Two Cases ', Can. J. Surg., 12, 453.
Injury July 1970
radiologically and sometimes a clear diagnosis cannot be made from anteroposterior, lateral, and oblique views. It may be necessary to take further radiographs with traction and in flexion. Sometimes tomograms are indicated. Widening of the space between spinous processes indicates disruption of the interspinous ligament, which with unilateral locking of the facets point to an unstable cervical segment. In such unstable cervical spines fixed traction is an urgent necessity because 1 in 10 patients with neck injury had a worsening of neurological damage during emergency care before skull traction had been applied. Treatment may be by continuous traction after reduction followed by support, or operative stabilization. If locking of the articular facets cannot be reduced by traction alone, open reduction and stabilization is required. Flexion injuries with subluxation are notorious for the rate of recurrence of deformity, and stabilization by wiring and grafting is required. It is important that the anaesthetist does not use a laryngoscope. Details of time required for traction and fixation as well as prognosis are clearly stated. AUFRANC, O. E., JONES, W. N., and BIERBAUM, B. E. (1969), ' R o t a r y Fracture-dislocation of the Cervical Spine ', J. Am. reed. Ass., 208, 1384.
Spinal Cord and Cauda Equina Bullet Injuries Tractor Driver's Spine In this paper the author claimed that the incidence of spinal degeneration is relatively high in rural populations and this is attributed to the repeated vibrational or rotational trauma to which the tractor driver's spine is exposed. It is suggested that one of the factors involved is a bad design of tractor seats as the more modern tractors do not have the original long steel spring which carried the seat on early models. An appeal is made for the better design of tractor seats and this is clearly directed to the manufacturers themselves. TROUP, J. D. (3. (1969), ' The Spine of the Tractor Driver ', Rural Med., 1, 9.
Great Toe Extensor Reflexes The tendon reflexes of the great toe are weakened by lesions of the fifth lumbar nerve-root. These reflexes require both care and practice if they are to be elicited reliably: the correct method is described in detail. TAYLOR, T. K. F., and WIENER, M. (1969), ' Great Toe Extensor Reflexes in the Diagnosis of Lumbar Disc Disorder ', Br. reed. J., 2, 487.
Snowmobile Injuries The commonest injury from riding Snowmobiles was compression fracture of one or more vertebral bodies due to a bumpy ride in a machine without shockabsorbing equipment. CHISM, S. E., and SOULE, A. B. (1969), ' S n o w mobile Injuries ", J. Am. med. Ass., 209, 1672.
Fracture-dislocation of Cervical Spine The fracture of the month (No. 95) presented by Dr. Boland from the Fracture Clinic of the Massachusetts General Hospital was a fracture-dislocation of the cervical spine. The important features of this injury are clearly outlined. It is frequently missed
The authors describe 65 civilians who had spinal cord or cauda equina bullet injuries. Forty-five had laminectomy and exploration and 20 did not. In all patients, no matter what category, recovery of neurological function was scant or absent. The follow-up showed that the patients with the cauda equina injuries fared better than those with spinal cord injuries. Predictions of the outcome on the basis of cerebrospinal fluid dynamics were not possible. The final state in these patients is closely correlated with the initial neurological situation rather than with surgery. It is suggested that laminectomy should be reserved for contaminated wounds and for cases where there is a progressively increasing neurological deficit. YASHON, D., JANE, J. A., and WHXTE, R. J. (1970), 'Prognosis and Management of Spinal Cord and Cauda Equina Bullet Injuries in Sixty-five Civilians ', J. Neurosurg., 32, 163.
Electronic Control in Acquired Spasticity For those concerned with the increasing problem of spasticity following severe head injuries there is some hope of improving the equinus position if a device described comes into general use. The article describes the effects of automatic electrical stimulation of nerves, especially the peroneal nerve. Useful results were obtained in the parallel problem following strokes. DIMITRIJEVIC, M. R., GRACONIN, F., PREVECT, T., and TRONTEU, J. (1968), 'Electronic Control of Paralysed Extremities ', Biomed. Engng, 3, 8.
Racecourse Medical Officer Years of experience have been distilled into ten minute's delightful reading. Any doctor who has undertaken similar duties will appreciate the excellent presentation of medical care at Cheltenham racecourse. The organization of medical cover, the types of injury to jockeys and spectators, and aspects of